The ABCs of Medicaid for Seniors
Medicaid is one of the most complicated and confusing areas of the law, and I often think it was done deliberately to prevent people from qualifying or to discourage them from trying to qualify. It is the government’s medical program for the poor.
Medicaid is often confused with Medicare, which is the federal government’s medical program for seniors. Almost all seniors qualify for Medicare, as long as they have contributed to the system during their working lives. For those older adults who do not qualify, they have the opportunity to “buy” the system by paying premiums set by the federal government. Medicare benefits are limited; therefore, seniors can purchase Medicare supplement or “Medigap” insurance policies that pay benefits where Medicare leaves them.
Medicaid, on the other hand, is a joint program between the federal government and the states to provide health care to the poor. As such, it is regulated first by Congress, then by state legislatures. Those lawmakers have set the standards by which Americans and permanent residents (and only those classes of individuals, not “illegal aliens,” to dispel a rumor) can qualify for government-paid health care. While ratings may vary from state to state, there are several concepts that apply across the board.
Although Medicaid has programs for poor people of all ages, my legal practice focuses on the elderly and those are the programs that I focus on. Depending on the state, Medicaid may offer nursing home care and / or home care for seniors in need. Most people are familiar with nursing home care programs, but home care programs, if they exist in your state, can offer a great alternative to nursing home care. New York, for example, offers nursing home care and also has an ambitious “community” or home-based Medicaid program; Florida, on the other hand, offers nursing home care and lets individual counties provide whatever home care they can afford.
The program most people are familiar with is nursing home care, referred to in New York as “Chronic Care Medicaid” and in Florida as “Institutional Care Medicaid.” If a person becomes so ill that they cannot perform certain Activities of Daily Living (ADL), it is not safe to live at home, and they need medical assistance, they may need ongoing care in a nursing home. Contrary to popular belief, Medicare (the senior program) does NOT pay for nursing home care; you only pay for limited “skilled nursing care,” which often takes place in a nursing home with rehabilitation facilities. A good “Medigap” policy will pick up where Medicare leaves off, paying up to 100 days in full for skilled nursing care.
However, if an older person needs permanent nursing home care, they will have to pay for it out of their own pocket, with long-term care insurance, or by qualifying for Medicaid. To those of you who can pay for your own nursing home care, congratulations. For those who own or are contemplating purchasing long-term care insurance policies, be a smart shopper: Those policies typically pay a set daily rate (a fraction of the full daily rate, especially over time) for care in a nursing home for a set period of time (usually just a couple of years) and often do not go into effect until the person remains in the nursing home for that many days. It is important to read these policies carefully and understand them.
The last option, Medicaid, is for the poor or those with modest assets. Whether a sick elderly person qualifies for Medicaid to pay for nursing home care depends on whether they made progress in Medicaid planning or are immediately qualified by their current financial status. Sometimes a person has to “spend” some of their assets before they qualify, although there are certain ways that some assets can be protected.
If you or your loved one are interested in learning more about Medicaid and proper planning for future qualification, make an appointment to see an elderly attorney who can review your financial picture and change a strategy to help meet your needs. future.